The Other Side of the Wafer-Thin Barrier

This week, SOAP (Speak Out Against Psychiatry) held a demonstration at the Institute of Psychiatry in London. It follows a long period of widespread criticism of the DSM and its political influence.
I'm with the SOAP people in spirit, because I think someone needs to hold up a mirror to psychiatry, and I hope that psychiatry will be smart enough to look earnestly at itself.

I've written a little about this (see here and here) but I am by no means the most vocal critic or the most prolific writer on the DSM5 and all its problems. A good distillation of the issues, which is kept up-to-date with current material, can be found on the Beyond Meds blog - the DSM update page is here.

The SOAP web page for this event is well worth a read. There, they explain their position that human suffering is more than a medical issue, and so we should not rely upon a medical treatment for wider problems. Normal human experiences, they say, are being medicalized which results in people being labelled.
I agree, and have agreed for some time.  The DSM5 threatens to turn grief into a disorder, and child tantrums into a disorder. This is a dangerous form of 'mission creep'.

My instinctive opposition to diagnostic labelling comes, I think, from what I have learned in my training and experience as a psychotherapist. I have also had some experience of the mechanisms of psychiatry and psychopharmacology, which lead me to believe that both practices have departed significantly from what I hold to be the work of healing mental illnesses.

An article shared on Twitter recently notes that "Psychiatry was not - on Freud's watch - to be swallowed by medicine". Perhaps Freud intended that psychoanalysis be practiced by people who did not go through the sheep-dipping of medical training, and who could connect in a different way to their 'patients' as a result. Clearly, Freud knew that looking at people through a medical lens could be an inherently limited approach.

It's interesting to note the boundaries getting fuzzy here, between psychiatry (which is a branch of medicine) and psychotherapy. It's true that some psychiatrists are also trained psychotherapists who have undertaken extensive personal therapy themselves. But it's true too that many psychiatrists are just doctors. Some of these doctors are working on the assumption that their medical degree and psychiatric training entitles them to carry out psychotherapeutic enterprises under the banner of psychiatry. They also work on the assumption that their medical training (and with this I include the social, cultural, and heirarchical effects of medical and psychiatric training) will not somehow infiltrate the relationship, and the treatment that they offer. As if the person that we are, and the experiences we have, can somehow be irrelevant once we are in the room with a patient.

No.

The article also quotes Robert Spitzer, who headed the development of DSM-III. In a hugely telling remark, he is reported to have said: "..looks very scientific..... It looks like they must know something". For me, this is symbolic of the eternal struggle of medicine as a science - to name, to understand, and thus to defend against the impossible anxiety of NOT knowing.

"The medical model is a wafer-thin barrier against uncertainty" - Irvin Yalom

So, I question psychiatry as it's practiced today because of its over-emphasis on naming, and understanding stuff - much of which (like grief, tantrums, and the stress of someone's death) is actually the stuff of LIFE and not really there to be understood through a medical model.
I want to be prepared to sit on the other side of that barrier, where there is chaos, confusion, or hurt, and allow that to be the stuff. Because that's what I believe people want and need from soul-healing.

Here's the article, by the way

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Living the Quiet Life - Some Thoughts on Humility

The new Pope has generated lots of discussion around the world over the past few weeks. (That's aside from the Catholic 'elephant in the room' of abuse, of course. But I'm not here to talk about that).
What struck me was what I heard about his lifestyle as a cardinal. He chose a small apartment, cooked his own meals, and used public transport. He made his lifestyle deliberately modest, in order to demonstrate his attitude to service.
Later, after the white smoke rose from the chimney, he emerged onto the balcony and made another demonstration of his attitude, by asking the people of the church to pray for him. And to pray with him. The ulterior: I'm just like you. We should do this together. I am not more special than you; in fact, I need your help in this job I'm going to do.
It feels to me that these are important demonstrations of humility and could be very helpful in the ongoing struggles of the Catholic church.

And then, more recently, I noticed it happening again: this time, Justin Welby, the new Archbishop of Canterbury. An innovative change to the normal ceremony - added by Welby himself - had him intercepted at the door of the cathedral by a youngster. It was quite something to watch.
See it here at about 2min 50sec.  
A 17-year-old asked him "Who are you? Who sent you? And what confidence do you come with?". His reply was "I'm just me, basically, and actually I know nothing. I'm not coming with confidence, I'm coming with fear. But I'm here to serve".
Again, I was struck by the sense of humility in this segment. It was a clear indication from the Archbishop that, despite the presumed power and authority of the position, he wishes to be seen as 'only' human.

I haven't seen such obvious public displays of humility in a long time. Most media output in the UK is dominated by people who exude quite the opposite; take Simon Cowell, for instance, whose self-absorption and grandiosity has actually become a kind of joke. Our culture seems to be evolving more and more in the other direction......

Being humble is weak.
You're under-rating yourself - brag a little to get ahead. **
In fact, brag a lot.
Brag louder, and more, than the others.
Don't be quiet or unassuming.
Quiet guys finish unnoticed.

In the therapy industry, the tide is also flowing that way. A colleague in the US has observed recently how counselling/therapy has become "commodified" - partly due, I think, to an increase in competitive marketing trends.
Yes, therapists are now bragging to get ahead, too. I have noticed it myself. I spotted someone on social media recently describing themselves as "known for quick results". Elsewhere, people offer 'testimonials' in their literature, perhaps unaware of the inherent bias. What I see is a widespread decrease in humility.
 Odd, perhaps, when the BACP Ethical Framework describes humility as one of the "personal moral qualities" essential in ALL therapists.

"Humility: the ability to assess accurately and acknowledge one’s own strengths and weaknesses." (BACP, 2013)

Personally, I would choose as a therapist (or refer clients to) someone who makes no bold claims on their website. If they did, it would turn me off. I like it when people suggest that therapy "may" be a real help, rather than saying it "can" change your life. Words are important; tone is important; the ulterior (unspoken) message is the one that really gets through.

Maybe we just need more of it in the world.....?
Generally, I think humility could make the world a bit less 'in-your-face'; a little quieter, perhaps. It might help us in recognizing ourselves and each other as normal, faulty human beings - rather than cultivating a culture of celebrity, competition, pressure on others, pressure on self.

The problem with humility is ... that to be humble involves just quietly getting on with what you do, making no song and dance about it, not asking for any awards or prizes (although BACP are offering them!). In an increasingly competitive commercial world, we are driven to NOT be quiet.


In general society, humility is normally practiced only in quiet corners (that's the point, after all). But as a result - the virtue, benefits, and rewards of humility are chronically under-advertised. So thanks be, to Pope Francis and Archbishop Justin.....
for making a song-and-dance about NOT making a song-and-dance.

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** In Transactional Analysis, there is a tradition of  using 'bragging' as something healthy. I broadly agree with this, because it's done in an I'm OK-You're OK spirit. In other words, it's not about bragging to be one-up on others; it's more to do with fighting the internal critic (or Pig Parent).
Bragging at the expense of others is a widespread behaviour which implies an "I'm better than them" position (I+U-). This may be significant of the "Take It" driver (Tudor, 2008).

Humility is an antidote to "Take It", as Tudor suggests: 
"Just as awareness and understanding helps the individual, so too the social psychological analysis of the social, political, and economic consequences of the 'Take it' driver message may help the social awareness of individuals, groups, peoples, and even nations to resist oppression and to commit to cooperation." 
 Sounds like humility in action to me. 

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Something in the air......

I was interested to read, after my cynical musings last time, that I'm not the only one to be asking who is making money from the DSM-5. Crazy thought it may sound, it seems that a large proportion of the DSM team have ties with drug companies. As they say - go figure.

I'm rather happy to see that there is a growing number of individuals, groups, and organizations who are rallying to show their opposition to DSM-x, on ethical, moral and political grounds. They range from the satirical: Here, on a page called DSMSucks! there is even a link to a "new psychiatric disease generator" which is funny and has a point ...

... to the serious call-to-arms of an 'occupy' movement who are planning a protest at the APA meeting in May. It has obvious echoes to a similar protest in September, 1969.

One of the root traditions of Transactional Analysis is that of Radical Psychiatry - a movement which sought a move away from diagnostic labelling, with all its interpersonal, societal and political implications, and back to the practice of 'soul healing'. This wasn't a 60's love-in... it was a move against the rise of Big Psych, one of Big Pharma's older cousins.

These days, the arguments are familiar and just as relevant. People are being labelled, and they shouldn't be. People are making money and gaining power over others because of this. The process is mystified so the power dynamics are camouflaged. People are alienated - from themselves, each other, the medical establishment, and from any feeling of what's normal and human.

"Call out the instigators, because there's something in the air
We've got to get together, sooner or later, because the revolution's near
.... and you know it's right" (Thunderclap Newman)

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